Comparing the Costs of Surveillance of Early-Stage Breast Cancer by Digital or Traditional Follow-Up Methods: Randomized Crossover Study.

Background: An increasing number of early-stage breast cancer (EBC) survivors and limited health care resources have raised interest in developing digital methods for communication between patients and health care personnel. In 2015, Helsinki University Hospital (HUS) Comprehensive Cancer Center (CCC) launched a digital solution called Noona (Helsinki University Hospital; Noona Healthcare) for patients with cancer, which allows patients to report their symptoms or side effects and ask questions with a computer or smart mobile device.

Objective: In this study, we compare the cost and contacts of surveillance of EBC by 2 follow-up methods: digital solution and phone calls during their first year of follow-up outside preplanned visits.

Methods: This was a prospective, open-label, randomized crossover study. After postoperative radiotherapy, patients with EBC were randomized to surveillance with either a digital solution or phone calls in addition to routine follow-up visits. After 6 months, the patient switched to the alternative follow-up method. All patients were thus exposed to both follow-up methods, and the order was determined by randomization. Hospital contacts and the costs of specialized health care were extracted from the Ecomed database of the Helsinki and Uusimaa Hospital District. The Ecomed database records all hospital costs. The costs of follow-up visits and diagnostics at the HUS CCC were analyzed in a repeated measurements general linear model analysis.

Results: The study extended from July 2015 to January 2017. Of 765 patients, 734 were included in the final analyses. For the digital solution group, the mean number of contacts per patient was 1.06 (SD 1.57) during the first 6-month period and 1.22 (SD 1.04) in the second period, with associated costs of €269 (US $313.21) and €311 (US $362.11). Similarly, in the phone call group, the mean number of contacts increased from 0.95 (SD 1.39) to 1.24 (SD 1.14) with the costs of €236 (US $274.78) and €344 (US $400.53), respectively. There were no statistically significant differences in the number of outpatient contacts (P=.46 and P=.35) or total costs (P=.80 and P=.12) between the 2 follow-up methods or randomization groups.

Conclusions: We did not find any statistically significant differences in the total cost of follow-up of EBC by digital solution or phone calls. The number of visits and costs were higher during the latter follow-up period, probably due to the scheduled routine 1-year visit. There were more visits and higher costs in the digital solution group during the first 6 months, but these were higher in the phone call group during the latter 6-month period. This shows that the digital solution may enable faster access to outpatient services than conventional follow-up.